Provider Demographics
NPI:1598837890
Name:NEWPORT BEACH GASTROENTEROLOGY ASSOC
Entity Type:Organization
Organization Name:NEWPORT BEACH GASTROENTEROLOGY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOTTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:UTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-631-2670
Mailing Address - Street 1:1525 SUPERIOR AVE
Mailing Address - Street 2:#104
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-631-2670
Mailing Address - Fax:949-631-7137
Practice Address - Street 1:1525 SUPERIOR AVE
Practice Address - Street 2:#104
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-631-2670
Practice Address - Fax:949-631-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty